Comparison of high saphenous ligation and stripping, radiofrequency ablation, and subfascial endoscopic perforator surgery for the treatment of active venous ulcers: Retrospective cohort with five-year follow-up

Objective To compare the use of high saphenous ligation and stripping, radiofrequency ablation, and subfascial endoscopic perforator surgery for the treatment of active venous ulcers. Methods One hundred ninety-five ( n = 195) subjects who were treated for venous leg ulcers were enrolled between 2009 and 2014. Three groups were formed (Group A: high saphenous ligation and total stripping, Group B: radiofrequency ablation of the great saphenous vein + perforators, and Group C: radiofrequency ablation of the great saphenous vein + subfascial endoscopic perforator surgery) ( n = 65 for each group). The venous clinical severity score for baseline, 1st, 6th, and 12th months, great saphenous vein occlusion at the 1st, 6th, and 12th months, and ulcer rates for the 1st, 2nd, 3rd, 4th, and 5th years were recorded. Results For venous clinical severity score, only the first month decrease was significant for the subfascial endoscopic perforator surgery group ( p = 0.001). Great saphenous vein occlusion was higher at the 6th and 12th months for the high saphenous ligation and stripping and subfascial endoscopic perforator surgery groups than for the radiofrequency ablation group ( p = 0.036 and p = 0.037). The rate of ulcers for the subfascial endoscopic perforator surgery group was lower at the second, third, fourth, and fifth years ( p = 0.011). No significant difference was found between groups for the five-year recovery rates ( p > 0.05). Conclusion Subfascial endoscopic perforator surgery technique in conjunction with radiofrequency ablation of axial vein was superior to both high saphenous ligation and stripping and radiofrequency ablation of axial and perforators for ulcer healing.

A COMPARATIVE STUDY OF CERTAIN FACTORS BETWEEN PATIENTS WHO UNDERWENT SUBFASCIAL ENDOSCOPIC PERFORATOR SURGERY [SEPS] VERSUS OPEN PERFORATOR LIGATION [OSPL] IN THE TREATMENT OF GREAT SAPHENOUS VARICOSE VEINS”

This comparative study was conducted from April 2018 for a period of 1 ½ years at ESIC MEDICAL COLLEGE & PGIMSR, K.K.NAGAR, CHENNAI -78 for a total of 50 patients who were diagnosed with Great saphenous varicose veins with perforator incompetence .Patients underwent open subfascial perforator ligation or subfascial endoscopic perforator ligation. The observation and inference is noted in this presentation.

A PROSPECTIVE COMPARATIVE STUDY OF RADIOFREQUENCY ABLATION VERSUS SUBFASCIAL ENDOSCOPIC PERFORATOR SURGERY FOR THE TREATMENT OF VARICOSITIES IN VARICOSE VEINS PATIENTS.

Introduction: Dilated & tortuous subcutaneous veins 3mm or more in diameter are known as varicose veins. When perforating veins become incompetent, it causes chronic venous insufficiency. Majority cases are managed conservatively. Cases with significant skin changes and ulcers, requires surgical procedures. Methods: A prospective comparative study of 30 patients of varicosities, divided into two groups, A and B according to CEAP classification were assessed for VCSS preoperatively. They underwent radiofrequency ablation (RFA) and subfascial endoscopic perforator surgery (SEPS) respectively and postoperative VCSS was calculated at follow up at 4 weeks. Collected data was assessed for the change in clinical severity of the disease and compared for the complications of both surgical methods. Results: The mean difference of pre op and post op VCSS in patient treated by RFA is 6.0 and the mean difference of pre op and post op VCSS in patient treated by SEPS is 5.4. Post RFA complications include pain (20%) and ecchymosis (13.3%). Paraesthesia and DVT was not noted. Post SEPS complications include pain (40%), ecchymosis (40%) and paresthesia (13.33%). DVT was not noted post SEPS. Only 1 case (6.66%) treated by SEPS developed recurrence post operatively. Conclusion: RFA and SEPS are two different approaches for varicosities, RFA being truncal therapy and SEPS for perforators, both are almost equally effective in context of postoperative hospital stay and improvement of VCSS; safe in terms of post op complications. Keywords: Radiofrequency ablation (RFA), Subfascial endoscopic perforator surgery (SEPS), venous clinical severity score (VCSS), varicose veins

ADVANTAGE OF SUBFASCIAL ENDOSCOPIC PERFORATOR SURGERY [SEPS] OVER OPEN PERFORATOR LIGATION [OSPL] IN TREATMENT OF GREAT SAPHENOUS VARICOSE VEINS-A COMPARITIVE STUDY

This comparative study was conducted at ESIC MEDICAL COLLEGE & PGIMSR, K.K.NAGAR,CHENNAI -78 for a total of 50 patients who were diagnosed with Great saphenous varicose veins with perforator incompetence for a period of 18 months from April 2018. Patients underwent open subfascial perforator ligation or subfascial endoscopic perforator ligation in a 1: 1 ratio by alternate allocation method. Odd numbered patients were treated by subfascial endoscopic perforator surgery and even numbered patients were treated by open subfascial perforator ligation . The observation and inference is noted in this presentation.

Surgical methods and clinical results of subfascial endoscopic perforator surgery in Japan

Objectives To clarify the surgical methods and the clinical results of subfascial endoscopic perforator surgery in Japan. Methods This study included 1287 limbs of 1091 patients who underwent subfascial endoscopic perforator surgery in 14 hospitals. Simultaneous saphenous vein treatment was performed in 1079 limbs (83.8%), and 118 limbs (9.2%) had deep venous lesions. The venous clinical severity score was calculated before and 6 to 12 months after surgery. The ulcer healing rate and ulcer recurrence rate were calculated cumulatively. Results Preoperative venous clinical severity score was significantly decreased from 10.0 ± 6.6 to 3.1 ± 3.4 ( P < .0001) postoperatively. The primary ulcer healing rate was 96.2% (332/345 C6 limbs) at an average follow-up of 47.7 months, and the ulcer recurrence rate was 12.0% (49/393 C5, C6 limbs) at the average follow-up of 46.0 months after the ulcer healed. Conclusion These results indicate that subfascial endoscopic perforator surgery is an alternative to improve the long-lasting disease severity and/or clinical outcome.